Provider Demographics
NPI:1023092368
Name:LAWRENCE C. ANTONUCCI MD LLC
Entity type:Organization
Organization Name:LAWRENCE C. ANTONUCCI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANTONUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-879-1500
Mailing Address - Street 1:415 ROUTE 24
Mailing Address - Street 2:SU E
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2920
Mailing Address - Country:US
Mailing Address - Phone:908-879-1500
Mailing Address - Fax:908-879-1515
Practice Address - Street 1:415 ROUTE 24
Practice Address - Street 2:SU E
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2920
Practice Address - Country:US
Practice Address - Phone:908-879-1500
Practice Address - Fax:908-879-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04759200207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2198207OtherGHI
2K5143OtherHEALTH NET
303755OtherUS STANLEY
IS055OtherOXFORD
109881OtherCHN
536P31OtherWELL CHOICE CHESTER
536P32OtherMORRISTOWN
2198207OtherGHI
536P32OtherMORRISTOWN
=========OtherTAX ID
303755OtherUS STANLEY
=========OtherBCBS
=========OtherBEECH STREET
=========OtherHEALTH CARE PAYER
2K5143OtherHEALTH NET
=========OtherDEVON
=========OtherQUALCARE
=========OtherUNITED HEALTH CARE
IS055OtherOXFORD
536P31OtherWELL CHOICE CHESTER
=========OtherBEECH STREET